Encuesta sobre el impacto de la pandemia COVID-19 en el consumo de medicamentos, drogas recreativas y bebidas alcohólicas en Argentina / Survey on the impact of the COVID-19 pandemic on the consumption of medicines, recreational drugs and alcoholic beverages in Argentina

Objectives: The objective of the study was to evaluate the behavior in the use of medicines, recreational drugs and the consumption of alcoholic beverages in the Argentine population during the course of the ASPO (Social, Preventive and Mandatory Isolation) due to the COVID-19 pandemic.Methods: An online survey was designed ad hoc and was available between June 28 and July 9, 2020 through Surveymonkey© and was disseminated through social networks. Univariate and bivariate analyzes were performed.Results: 43.6% of the 2,906 participants reported using medications for chronic diseases. A significant difference (p= .000) was observed in the decrease in consumption between those who were treated in public health care providers (17.9%) and those who did it in private medicine (7.2%). Likewise, a significant difference was found in the decrease in access by the area of residence (p =.031), being lower in the City of Buenos Aires (6.8%) than in the rest of the national territory (10.6%). Of the total of individuals surveyed, 38.3% reported having self-medicated during the ASPO, of these 59.3% did not alter their self-medication routine, 15% decreased their consumption and 25.7% increased it.23.9% of the sample reported consuming recreational drugs. 47.8% of users reported having increased consumption. Likewise, 66.3% reported drinking alcohol regularly, and of these, 40.1% increased their consumption.Conclusions: It is important to continue the care of chronic diseases, mental health and substance use. In particular, strengthening the public health system and the provinces. (AU)

Objetivos: El objetivo del estudio fue evaluar el comportamiento en el uso de medicamentos, drogas recreativas y el consumo de bebidas alcohólicas en la población argentina durante el transcurso del ASPO (Aislamiento Social, Preventivo y Obligatorio) por la pandemia de la Covid-19.Métodos: Se diseñó ad hoc una encuesta on-line disponible entre el 28 de junio y el 9 de julio del 2020 mediante Surveymonkey© difundida por redes sociales. Se realizaron análisis univariados y bivariados.Resultados: El 43,6% de los 2.906 participantes reportó utilizar medicamentos para enfermedades crónicas. Se observó una diferencia significativa (p=,000) en la disminución del consumo entre quienes se atienden en efectores públicos (17,9%) y quiénes lo hacen en la medicina privada (7,2%). Asimismo, se encontró una diferencia significativa en la disminución del acceso por la zona de residencia (p=,031), siendo menor en Ciudad de Buenos Aires (6,8%) que en el resto del territorio nacional (10,6%). Del total de individuos encuestados, el 38,3% refiere haberse automedicado durante el ASPO, de estos el 59,3% no alteró su rutina de auto-medicación, el 15% disminuyó su consumo y el 25,7% lo aumentó.El 23,9% de la muestra manifestó consumir drogas recreativas. El 47,8% de los usuarios informó haber aumentado el consumo. Asimismo, el 66,3% informó tomar alcohol regularmente, y de éstos, el 40,1% aumentó su consumo.Conclusiones: Es importante continuar la atención de las enfermedades crónicas, la salud mental y el uso de sustancias. En particular reforzando el sistema público de salud y del interior del país. (AU)

The effect of protease inhibitor-based dual antiretroviral regimens on CD4/CD8 ratio during the first year of therapy in ART-naïve patients with HIV-infection.

OBJECTIVES: To assess the effect of protease inhibitor (PI)-based dual therapy on CD4/CD8 ratio during the first year of therapy in antiretroviral therapy (ART)-naïve patients using data from randomized controlled clinical trials. METHODS: We pooled data from the GARDEL and ANDES studies, both randomized controlled clinical trials that recruited ART-naïve people living with HIV and randomly assigned them to receive PI-based dual therapy (DT) or triple therapy (TT) aiming to compare viral efficacy. We compared median CD4/CD8 ratios and the proportion of patients with CD4/CD8 ratio > 1 at 48 weeks after ART initiation in both treatment arms using the Mann-Whitney U-test and the χ2 test. We performed subgroup analysis for patients > 50 years old, with baseline CD4 counts ≤ 200 cells/µL, viral load > 100 000 HIV RNA copies/mL, and ritonavir-boosted lopinavir-based therapy. RESULTS: We analysed data from 571 patients: 292 on DT and 279 on TT. No differences were observed in CD4/CD8 ratio (0.632 vs. 0.617, P = 0.729) or in the proportion of patients with CD4/CD8 ratio > 1 (17.9% vs. 19.3%, P = 0.678) 48 weeks after ART initiation. Subgroup analysis showed no further differences. CONCLUSION: The impact of PI-based DT regimens on the CD4/CD8 ratio during the first year of treatment for ART-naïve patients is similar to that of TT.

Bioinformatic analysis of post-transmission viral readaptation in Argentine patients with acute HIV-1 infection.

During the acute phase of HIV-1 infection, a strong readaptation occurs in the viral population. Our objective was to analyze the post-transmission mutations associated with escape to the cytotoxic immune response and its relationship with the progression of the infection. In this study, a total of 17 patients were enrolled during acute/early primary HIV infection and 8 subjects that were the HIV positive partner resulting in 8 transmission pairs. Genotyping of the genetic polymorphisms of HLA class I A and B was performed using PCR-SSOP. Viral RNA extraction was from plasma. 570 single Gag-gene amplifications were obtained by limiting-dilution RT-PCR. Epitope prediction was performed with NetMHC CBS prediction server for the 19 HLA-A and B alleles. Cytotoxic response prediction was performed by using the IEDB Analysis Resource. From our results, we deduce that the transmitted CTL / gag escape frequency in the founder virus was at least double compared to the post-transmission events. Additionally, by means of an algorithm that combines these frequencies, we observed that the founder viruses better adapted to the HLA A / B alleles of the recipient could contribute to a greater progression of the infection. Our results suggest that there is a large adaptation of HIV-1 to the HLA A / B alleles prevalent in our population. However, despite this adaptive advantage, the virus needs to make "readjustments" through new escape and compensatory mutations. Interestingly, according to our results, this readaptation could have a role in the progression of the infection.

Use of darunavir and enfuvirtide in a pregnant woman.

SUMMARY: A 41-year-old pregnant woman with multiple virological failures started darunavir, enfuvirtide, zidovudine and lamivudine at week 28 of pregnancy. During week 38, the patient had a viral load <400 copies/mL and a CD4 count of 180 cells/mm(3) (13%). The child was found to be in good health, with negative HIV-polymerase chain reactions at birth, at two and at six months.

Acute meningoencephalitis due to human immunodeficiency virus type 1 infection in 13 patients: clinical description and follow-up.

The objective of this study is to describe a series of cases of severe meningitis caused by human immunodeficiency virus type 1 (HIV-1) occurring during primary infection or after antiretroviral treatment interruption. In an observational cohort study, 13 patients with clinical diagnosis of meningitis or meningoencephalitis were reviewed. Ten cases occurred during primary HIV-1 infection and 3 after antiretroviral therapy (ART) withdrawal. Demographic parameters, clinical presentation and outcome, and laboratory and cerebrospinal fluid (CSF) parameters were recorded. The risk factor for HIV-1 infection acquisition was sexual transmission in all cases. The most frequent systemic symptoms were fever (12/13) and headeache (9/13). Among neurologic symptoms, focal signs appeared in seven patients (53.8%), confusion in six (46.2%), and agitation in five (38.5%). The median CD4 cell count was 434 cells/mm3. In all cases, CSF was a clear lymphocytaire fluid with normal glucose levels. Cranial computerized tomography was performed in seven patients, with a normal result in all of them; brain magnetic resonance in eight patients was normal in five cases and showing cortical atrophy, limbic encephalitis, and leptomeningeal enhancement in one patient each. The electroencephalographs (EEG) just showed diffuse dysfunction in three cases. ART was started in 11 patients. HIV RNA load at 12 months was <50 copies/ml in all treated patients. The 13 patients recovered without neurologic sequela. Meningitis or meningoencephalitis during primary HIV-1 infection or after ART cessation are unusual but sometimes a life-threatening manifestation. Although all patients tend to recover and the necessity of ART is not well established, some data suggest its potential benefit in these patients.

HIV-1 infected patients older than 50 years. PISCIS cohort study.

OBJECTIVE: The aim of this study is to characterize the ways in which older HIV-infected people differ from younger HIV-infected people. METHODS: Prospective cohort study. PISCIS cohort includes newly attended HIV-infected subjects since January 1, 1998. Naive patients were selected. Two groups were defined: G1 (>or=50 years at time of diagnosis, n=493) and G2 (18-49 years, n=4511). Statistical analysis was performed using chi(2), Student's t test, Cox regression and linear mixed models. RESULTS: G1 had different features: males (G1: 84% vs. G2: 75%, p<0.001), sexual transmission (52% vs. 32%, p<0.001), AIDS at first visit (38% vs. 22%, p<0.001). The follow-up was 6 years. Ninety-five percent of patients in G1 and 92% in G2 presented a detectable viral load (>or=500 copies/mm(3)) at the first visit (p=0.016). G1 presented lower CD4 levels with respect to G2 throughout the period but the increase of CD4 in G1 at the end of the study period was 254 cells/mm(3) whereas for G2 it was 196 cells/mm(3) (p<0.001). Mortality was 9% for G1 and 4% for G2 (p<0.001). CONCLUSIONS: HIV-infected people diagnosed at the age of 50 years or older showed different features. They showed good viral and immunological response to HAART.

Staphylococcus lugdunensis infective endocarditis: description of 10 cases and analysis of native valve, prosthetic valve, and pacemaker lead endocarditis clinical profiles.

OBJECTIVE: To evaluate the incidence and the clinical and echocardiographic features of infective endocarditis (IE) caused by Staphylococcus lugdunensis and to identify the prognostic factors of surgery and mortality in this disease. DESIGN: Prospective cohort study. SETTING: Study at two centres (a tertiary care centre and a community hospital). PATIENTS: 10 patients with IE caused by S lugdunensis in 912 consecutive patients with IE between 1990 and 2003. METHODS: Prospective study of consecutive patients carried out by the multidisciplinary team for diagnosis and treatment of IE from the study institutions. English, French, and Spanish literature was searched by computer under the terms "endocarditis" and "Staphylococcus lugdunensis" published between 1989 and December 2003. MAIN OUTCOME MEASURES: Patient characteristics, echocardiographic findings, required surgery, and prognostic factors of mortality in left sided cases of IE. RESULTS: 10 cases of IE caused by S lugdunensis were identified at our institutions, representing 0.8% (four of 467), 1.5% (two of 135), and 7.8% (four of 51) of cases of native valve, prosthetic valve, and pacemaker lead endocarditis in the non-drug misusers. Native valve IE was present in four patients (two aortic, one mitral, and one pulmonary), prosthetic valve aortic IE in two patients, and pacemaker lead IE in the other four patients. All patients with left sided IE had serious complications (heart failure, periannular abscess formation, or shock) requiring surgery in 60% (three of five patients) of cases with an overall mortality rate of 80% (four of five patients). All patients with pacemaker IE underwent combined medical treatment and surgery, and mortality was 25% (one patient). In total 59 cases of IE caused by S lugdunensis were identified in a review of the literature. The combined analysis of these 69 cases showed that native valve IE (53 patients, 77%) is characterised by mitral valve involvement and frequent complications such as heart failure, abscess formation, and embolism. Surgery was needed in 51% of cases and mortality was 42%. Prosthetic valve endocarditis (nine of 60, 13%) predominated in the aortic position and was associated with abscess formation, required surgery, and high mortality (78%). Pacemaker lead IE (seven of 69, 10%) is associated with a better prognosis when antibiotic treatment is combined with surgery. CONCLUSIONS: S lugdunensis IE is an uncommon cause of IE, involving mainly native left sided valves, and it is characterised by an aggressive clinical course. Mortality in left sided native valve IE is high but the prognosis has improved in recent years. Surgery has improved survival in left sided IE and, therefore, early surgery should always be considered. Prosthetic valve S lugdunensis IE carries an ominous prognosis.

Las infecciones en los pacientes con trasplante de órganos sólidos

Las infecciones en los pacientes trasplantados son más frecuentes y habitualmente más graves, con mayor tendencia a la diseminación y con patrones en ocasiones diferentes que en la población general. En esta revisión se expone una evaluación pre y postrasplante, desde el punto de vista cronológico, de las infecciones más frecuentes y de las medidas preventivas. Con la generalización de los trasplantes de órgano sólido y la mayor supervivencia de los pacientes, cada vez con más frecuencia los médicos de cabecera deberán asistir al control, prevención y tratamiento de estas infecciones y diferenciar los episodios banales de aquellos que exigen una rápida y más compleja evaluación, y a veces un ingreso hospitalario. El médico de cabecera puede colaborar con el equipo de trasplante al derivar a un paciente para evaluación a través de una historia clínica cuidadosa y la realización de algunos exámenes previos. Algunos pacientes pueden ser complejos por sus antecedentes, factores de riesgo y las posibles interacciones farmacológicas que se pueden ocasionar con nuevos medicamentos, por lo que una fluida comunicación entre el médico de cabecera y el especialista del equipo de trasplantes del hospital es fundamental para asegurar una buena calidad de atención al paciente. Algunas recomendaciones sencillas en cuanto a vacunaciones, comidas y protección contra la exposición pueden ser muy efectivas para evitar infecciones potencialmente serias. La introducción de nuevos fármacos inmunodepresores y nuevas estrategias profilácticas van a cambiar el espectro de infecciones a mediano plazo y probablemente aumentar aún más la supervivencia y calidad de vida de los pacientes portadores de algún órgano trasplantado (AU)